Provider Demographics
NPI:1063624245
Name:CLICK, GERRI COLLEEN (PTA)
Entity type:Individual
Prefix:
First Name:GERRI
Middle Name:COLLEEN
Last Name:CLICK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N BRADNER AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2449
Mailing Address - Country:US
Mailing Address - Phone:765-662-3981
Mailing Address - Fax:765-662-3987
Practice Address - Street 1:505 N BRADNER AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2449
Practice Address - Country:US
Practice Address - Phone:765-662-3981
Practice Address - Fax:765-662-3987
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06002031A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant